[ Read before Bureau of Clinical Medicine at the Southern Homoeopathic Medical Association, at St. Louis, Mo., October 13, 1938.]
By J. D. VARNEY, M.D.
(From the Journal of the American Institute of Homoeopathy.).
IN the last decade deaths from heart disease (especially coronary) have been increasing with alarming rapidity. This depression with all its headaches and financial difficulties doubtless has something to do with it, as well as our fast living ; use of tobacco, liquors, etc., are all prime factors in this trouble.
In a survey of 2,000 cases by the Mayo Clinic, doctors were found to head the list by two to one, bankers coming second and lawyers and preachers tying for third place and labourers constituting a poor fourth. So it would seem that the long, arduous training and mental strain of a physicians work have something to do with the condition.
A physician;s first duty in treating disease is to remove the cause, but as we cannot control the lives of our patients it is up to us to find the best method of relieving this condition and prolong lifes span as long as possible.
While my subject is entitled “better prescribing” in heart cases, I would like to make it a general plea for better prescribing in all cases of disease. Of course, in a paper of this kind time will not permit of great detail, so I shall attempt only to outline a principle (for those of you here who do not understand Homoeopathy0 and a few of the more common heart ailments which we see in everyday practice.
The longer I live and practice medicine the more I see and feel the fallacy of slipshod ,methods of prescribing, and the seeking for specifics to cure from a pathologic standpoint (there are no specifics). Of course, every system of medicine has its virtues but to my mind all are inferior to Homoeopathy, for they cure only when they are homoeopathic to the case.
Those of you who prefer to use cured methods I would advise to stick to crude Homoeopathy rather than resort to poisonous drugs before their merits have been determined. To convince one of the truth of this statement, we have only to review the literature of the past decade and note the trouble caused by using dangerous drugs.
You remember a few years ago they brought out dinitrophenol and every old-school journal in the country was full of the wonderful treatment they had discovered for obesity, but soon their enthusiasm began to cool when reports of blindness came pouring in from all parts of the country. Then came cinchophen and a like advertisement, and again like reports soon began to come in from deaths of cirrhosis of the liver from its use, and after it was too late came the caution to be careful of its use, for it is dangerous.
Then the last but not least was the late lamented sulfanilamide which, as you remember, has around 117 deaths officially recorded due to its use- and we do not know how many more that were not reported. Now let me ask in all candidness does it pay to fool with such remedies when we know we can save these lives if we take a little time to become more proficient in individual prescribing in a system that has been proven safe and sound ? Now lets see why this statements is true : Homoeopathy teaches us that drugs do not act directly on any pathologic condition, but act through the blood stream, assisting nature in building up anti-bodies which combat the disease.
We also known that about 25 per cent. of the patients consulting doctors do not have any pathologic condition. So if you attempt to prescribe for these patients from a pathologic standpoint, you only poison your patient and create a condition worse than the supposed disease. However, we do know whether it be a a disturbed physiology or some pathology, it will produce some irritation on the organ or tissue affected and that this disturbance will be transmitted through the afferent and efferent nervous and manifest some symptoms.
It may be a nerve pain, a soreness in some muscle or a stiffness in a joint. These are all subjective symptoms and can be noted only in the human, but when recorded become important guides in prescribing a drug which is know (through provings) to produce similar symptoms on the human body.
Knowing this, could there be anything more logical than to believe that this drug would have some action upon this disturbed condition ? But you say what is this action-just how does it do it ? Well, tell me just how or why does bichloride of mercury produce acute nephritis or strychnia cause paralysis of the spinal cord ? If this question could have been answered, the whole question of drug action would have been settled a long time ago.
But just as we know the mercury and strychnia do cause pathologic conditions, just so do know that these same condition. If it is known that we can take these dangerous drugs and render them non-poisonous by trituration and still increase their power to cure disease, any honest unprejudiced mind would have to admit that such a system is superior to one using dangerous poisonous drugs that kill.
This is Homoeopathy and it embraces the only curative law thus far known in medicine. Its principals cannot be blotted out ; they may be exploited under another name. Still these same principles constitute the only curative measures known outside of the homoeopathic remedies. I refer to the vaccines, serum and allergic remedies which are homoeopathic in principle whether they go under that name or not.
Each day the homoeopathic principle is being exploited more and more and some day will become the universal law of medicine regardless of what it is called. Remember there is a great field still to be explored under the similia law.
About four years ago one Dr. Peck of New York City came out with an article in Popular Science lauding the wonderful action of lachesis, that which he had just discovered, by using it in dilution one in 3,000 it would check haemorrhage.
I answered the article and was surprised to have Popular Science give me space enough to tell its readers that Constantine Herring brought the first snake poison into America in 1828, and that the Homoeopaths had been using it ever since. Even the pictures were taken from Boericke and Tafels catalogue which they have used since opening a homoeopathic drug house.
A short time ago Dr. James Small of Philadelphia published an article in which he started by saying that this will sound like Homoeopathy but has nothing to do with it. He had found that by diluting streptococcic serum 1-16 and injecting 5/100 of cc. it would control some forms of arthritis and rheumatoid carditis. He also found that a dose small enough not to cause severe reaction was the best. So I think the trend of all schools is to the small dose. We now put 4 oz. of iodine into a standpipe of water to prevent goitre ; also a small amount of chlorine in a like amount of water to prevent typhoid and it works.
No one would advise large doses of the tincture of iodine to school children to prevent goitre. So I think it is logical to see that the smallest possible dose to bring about reaction is the best treatment. This is as true in heart disease as any other. Why is it that mortality rate is so much higher in coronary troubles under other treatment ?
Simply because the idea of pathologic prescribing will not work work ; their sheet anchor of the xanthine group has been proven by Gold and Otto of New York to be of No therapeutic value, so all that is left is large doses of morphine to kill the pain, and if the already damaged heart can stand the added poison, they are too often followed by a large dose of digitalis, which usually completes the job.
Now do not think that digitalis is not a good remedy for heart condition, for it is one of the best, when indicated ; but it is very seldom, if ever, indicated in coronary conditions, and I very much doubt if ever indicated in physiologic doses for the so-called digitalization ; for as you know it acts profoundly upon the muscular substance of the heart and arteries through the pneumogastric and vasomotor nerves, causing violent systolic contractions which go on to paralysis in poisoning by the drug. In digitalization we get the physiologic action and if the heart muscles is not strong enough to stand the strain it is just too bad.
How many of you have ever used Aconite in coronary conditions? If you have used it or studied its action, you have noticed that it has almost a complete picture of this condition. Your severe agonizing pain often accompanied with numbness, great anguish of mind and fear of death, extreme restlessness, oppressed breathing, tachycardia, sensitiveness to all noise, intermittent pulse, increased desire to urinate, etc. Another symptoms that has been noted by several different prescribers and claimed to be pathognomonic of coronary disease is a “bright redness of the hypothenar eminences”.
All these symptoms come under Aconite, and if you use it early you will not be called upon to use morphine. And while on Aconite dont forget that it is indicated in “peri- and endocarditis” of acute rheumatic origin, and when used early will prevent 90 per cent. of the trouble from ever developing. You know that many writers now believe that acute rheumatic fever is a product of heart disease in place of the heart disease being caused by the fever.
Latrodectus is another remedy that comes in for equal honours in coronary disease. It attacks the entire precordial region, causing violent griping pain extending to the axilla, down left arm and often up into the neck and back of the head. Patient fearful and screams with the pain, dyspnoea severe. Patient fears he will lose his breath. Has numbness in lower limbs and a sinking sensation in epigastrium, which increases his fear of death.
Cactus.- Indicated when you have that characteristic iron-band constriction. Patient in a cold sweat, pain running down left arm and ring finger. The pains of Cactus are not usually over the whole left chest but seem to start from the apex of the heart and shoot upwards. They are aggravated by pressure and lying on left side.
Spongia is a remedy often forgotten in these cases. Patient awakened usually after midnight with a violent pain, badly frightened and thinks he will suffocate. Has violent palpitation heart feels as if it were trying to push its way up through the chest.
These are desperate cases and a doctor is anxious and worried and inclined to resort to morphine, but if you keep your head and know you materia medica you will relieve your patient and will not have to combat the damage done by morphine. Of course, you will have to treat your patient after the acute attack and here dont forget NAJA ; it is especially indicated in thrombosis, which will rapidly form an embolus if not checked. Following this probably Crataegus is one of our best remedies, but almost any remedy might be indicated, for it is the patient you are treating and not one symptoms.
Angina pectoris often is confused with coronary disease and rightly so, as sometimes it is very difficult to make a correct diagnosis. However, there are a few symptoms that will help to distinguish between them. In angina the patient will get into a certain position and will not move for fear of increasing the pain, while in coronary trouble the patient will move about trying to find some position to relieve the pain. Angina will be benefited by the nitrites, while they have little or no effect on coronary conditions.
In angina both the pulse and blood pressure will be accentuated, while in coronary trouble the pulse is apt to be irregular but the blood pressure is usually low, and a rise in same is a good symptoms. For an acute attack Amyl nitrite, Glonoin, Cactus or perhaps some of the above-mentioned remedies will usually control, but as this is purely nervous trouble the after-treatment must be directed to the constitutional nervous condition.
Mitral Cases.- Another condition that gives us a good deal of concern is the old mitral case. The heart of fifty or sixty with a history of “Flu” or pneumonia of inflammatory rheumatism, a heart that perhaps has already been weakened by heavy drinking or some other physical ailment, falls easy prey to this infection. Examination reveals dilatation, especially of the left side, marked mitral murmurs, first sound weakened or obliterated altogether, a failing compensation, oedema about the ankles, may or may not find albumin in the urine.
Anyway, it is the beginning of the end unless checked immediately. You may be called in the night and find the patient rapidly failing perhaps unconscious, with weak, rapid, irregular pulse, loud irregular breathing. Often incontinence. These are cases needing immediate stimulation to support the failing heart, so a hypodermic of Glonoin or Coramin.
The latter I always give into the blood stream ; it is about as quick in action as Glonoin and lasts much longer, and will usually stimulate the failing heart and keep the patient alive until you can substitute some of the more substantial remedies. You often will get fibrillation but don;t think you have to give Digitalis or Quinidine in large doses for Digitalis or China in potency will do the work for you.
Crataegus to follow up will do wonders in these old cases. It acts through the cardio-inhibitory vagus, strengthens and slow the hearts action. Especially indicated in high tension, this remedy alone will often keep these old cases alive and comfortable for years. It does not have an accumulative effect and can be given in substantial doses over long periods of time with no danger.
Digitalis in potency is indicated when the muscle is weak and accompanied with a good deal of dropsy. It stimulates the cardiac ganglion, it has an accumulative effect and is very slowly eliminated and must be carefully watched.
THE keynote of this drug is restlessness and peevishness with pain and all the symptoms are relieved by active or passive motion. The child is bad tempered with pain, asks for a toy and throws it at the head of the nurse and wants to be carried about the nursery all the time. It is excellent for severe pains in all potencies and occasionally high potencies, such as the 200th, are best.
Adonis vernalis often is an excellent remedy to follow Digitalis. It also has also good deal of dropsy, the weak slow pulse, low vitality, a fatty heart accompanied with a good deal of pain, and does not have the accumulative effect of Digitalis.
Strophanthus has much the same indications as Digitalis. Especially indicated in tobacco smokers, does not have the accumulative effect, does not affect the vasomotor nerves ; this it is much safer for the old, weak heart, especially when there is threatened oedema of the lungs.
The old cardiorenal case is like the poor : we have them with us always. And in the treatment of these cases I would like to give three of four outstanding cases and their treatment :.
Mrs. F.- The patient, a female fifty years old, was found sitting and partly lying on sofa with the limbs over the edge and and feet on floor. The limbs were burst open in many places and discharging serum which was running across the linoleum. Examination revealed a marked mitral murmur as well as an aortic regurgitation. The mitral murmur was well transmitted to all parts of the chest. Heart enlarged transversely, accentuation of the second pulmonary sound.
Failing compensation with marked hypostatic congestion through lower lobes of lungs. Dyspnoea so great that she could scarcely talk. Abdomen seemed to contain buckets of water which was causing a good deal of pressure upon the heart. The urine when examined contained large quantities of albumin and casts and some pus cells. A short history was obtained from the husband which he admitted showed a plus Wassermann.
She was given intravenous injections of a mercury preparation called Novasurol, and given Digitalis in potency, with the most marvellous action I have ever seen. Within three days the dropsy had all disappeared and the woman could lie down in comfort. She was then placed on Crataegus which carried her through for six years, and she not only did her housework but cared for a large garden.
Mr. P., captain of the Civil war, was another case given up by his physician. His examination was essentially the same as the former case except he had no aortic lesion and practically no dropsy. He was placed on Crataegus and lived for five years and enjoyed very good health, finally dying from the infirmities of age.
Mrs. A., female, age forty-eight, had been sitting in a chair for weeks unable to breathe at all lying down. Her dropsy was also extremely marked ; her limbs also had burst and were discharging serum freely. Her heart was enlarged and had all the abnormal sounds ever heard in one heart. Action was extremely weak and was accompanied by nausea and faintness. The urine was suppressed and passed only by drops. The least movements caused violent palpitation. She was given Digitalis which has removed all symptoms except the murmurs. This was ten years ago and she is able to do her own work and goes to town like any other woman. Seems perfectly well.
Mabel H.- One more case and I will stop. This was a case of a “blue-baby” in which the valve never closed, and at the age of eighteen months she became paralysed on the entire right side. At the age of four the case was turned over to me by another doctor who had failed to help her at all. She had NO use of the right leg and very little of the arm. The cyanosis was extremely marked ; her tongue was as black as that of a Chow dog.
Her heart had NO normal sounds and evidence of some degeneration of the pulmonic valve which gradually increased as she grew older. Under Gelsemium she was relieved of the paralysis and got so she could walk with the support of something to steady her. She was kept on Crataegus with now and then a dose of some other indicated remedy, and lived to be fourteen, which I understand is several years longer than any other like case on record.
Of course, in treatment of these cases as well as any case it is essential to look after the bowels, the diet, see that they have proper rest, and correct any abnormal condition that they may have ; and i believe as times goes on and we better understand the vitamins, that they will become one of the greatest adjuncts we have in medical. But dont forget that even the heart may be only one symptoms of a diseased body which must be treated as a composite whole and not as a single unit.